CHIP Lecture: 'Planning for mHealth in a Low Income Country – Challenges in Guatemala'

Poverty, genetics, and cardiovascular disease (CVD) combine to form a lethal mix in Guatemala, requiring creative and comprehensive approaches to ameliorate the situation. This presentation will illustrate the planned “digital eco-system” roadmap of MoTeCH, CommCare HQ, and Open MRS in Guatemala and the challenges encountered along the way.

In 2011, the UN Human Development Index (an indicator of education, health, poverty, etc.) ranked Guatemala at number 131 out of 187 countries globally. Numerous social and environmental dimensions of health contribute to marked level of childhood malnutrition, stunting, and anemia, while a high percentage of child-bearing women are obese and hypertensive. This has been referred to as “starving with a full stomach”. The number of deaths attributable to CVD in Guatemala increased by a staggering 61% between the years of 1990-2005 -- and the trajectory continues.

In 2012, we partnered with a NHLBI Center of Excellence in Guatemala City to create a roadmap for an eHealth intervention that could be used to reverse some of the disturbing health trends emerging in country. To address the multi-pronged issues of Guatemala’s increasing non-communicable disease (NCD) rate also required assessment of, and interventions at, the primary care level. Health posts, located in remote areas, are typically staffed by low-skilled auxiliary “nurses” and community health workers who are untrained in NCD, with very high case loads. Indigenous peoples (Mayans), already at genetic risk of CVD and distinctly marginalized, are particularly disadvantaged. The bright spot is that over 80% of Guatemalans have cell phones and the tele-connectivity is very dense across this Central American country. Part of the roadmap has been to simultaneously address the use of eHealth approaches for educating the ANs and the CHWs in the health posts, creating connectivity between health posts and the health centers where more expert practitioners are located, and working to influence patient behaviors via the use of text messaging. This presentation will illustrate the planned “digital eco-system” roadmap of MoTeCH, CommCare HQ, and Open MRS in Guatemala and the challenges encountered along the way.